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Q: Will the health law result in my Medicare benefits being cut?

A: Despite rhetoric to the contrary, Medicare advocates agree that the law, while including efficiencies that extend the cash-strapped program's solvency by several years, doesn't trim basic benefits at all.

"Not a single guaranteed benefit in Medicare is cut, and, in fact, benefits are improved," the Center for Medicare Advocacy said.

Q: How can it be that the government plans to cut $455 billion out of Medicare and other health programs over 10 years without affecting benefits?

A: Medicare is the great engine driving health care costs higher, and the law aims to slow that engine down in several ways. Under the law, Medicare will have to test payment systems that aim to promote better coordination of care while improving its quality. The goal is to cut down on duplication of services and to make sure seniors don't receive care they don't need.

There's also an emphasis in making Medicare more efficient in parts of the country like South Texas, where it costs more than twice as much as it does in Buffalo.

While providing more money to fight Medicare fraud, the law also sets up an independent payment advisory board that will recommend ways for Medicare to save money and extend its fiscal solvency.

Those measures account for more than half the Medicare savings, but the biggest single line item will be about $200 billion in cuts in the Medicare Advantage program, in which the government subsidizes private insurers like HealthNow and Independent Health to offer health maintenance organizations to seniors. The government pays about 14 percent more for Medicare Advantage than it does for regular Medicare, and starting in 2012, that subsidy will be reduced.

Q: Does that mean if I am on Medicare Advantage my benefits may be cut?

A: Possibly. AARP notes that some Medicare Advantage plans now offer perks such as gym memberships and free eyeglasses -- and that such giveaways will be the first thing to go if plans have to trim back benefits.

Co-pays and other costs to Medicare Advantage patients could also increase under the law, said AARP, which supported the health care reform effort.

Q: How does the law affect the Medicare Part D prescription drug plan?

A: Most importantly, it phases out the much-loathed "doughnut hole" in the prescription drug plan. Currently, Medicare recipients who spend $2,700 a year on drugs don't get any more benefits until they have spent $6,154.

That will start to change this year, when people who fall into the doughnut hole will get a $250 government rebate. Next year, those people will get a 50 percent discount on brand-name drugs. From there, the government will slowly phase out the doughnut hole and close it entirely by 2020, when 75 percent of drug costs will be covered.

Q: How will the new independent Medicare payment advisory board work, and what effect will it have?

A: The board will recommend payment cuts when it determines that a particular Medicare provider is being overpaid. Starting in 2014, the panel's recommendations will automatically take effect unless Congress acts to stop them.

While it is too soon to know how much savings the board will find, some experts think drug and medical-device makers are at most risk of seeing their payments cut.

Q: Are there any hidden benefits for seniors in the law?

A: Yes. Starting next year, Medicare will cover annual wellness visits for seniors. In addition, starting next year, Medicare will cover all preventive services for seniors, such as colonoscopies and mammograms.

Q: What ever happened to the provision in the bill that Sarah Palin described as creating "death panels"? While the House version of the bill included a provision offering end-of-life counseling to seniors, the Senate excluded it from its bill, and the provision was not included in the final legislation.

Supporters of the provision said it was a wild stretch to think such counseling sessions would in any way lead to the government deciding who could live or die.


>"After a few years of this (drug costs), we won't have anything left."

Gayle Abraham feels the pain of the Medicare prescription plan's "doughnut
hole," and not only in her wallet.

Disabled with rheumatoid arthritis and on Medicare, the 64-year-old West Seneca woman is taking her key pain-relieving prescription every 10 or 14 days rather than every seven days as the doctor prescribes. She's hoping to make the doctor's samples last so she doesn't have to start paying $1,800 a month for her medication.

"Believe me, when I let it go 10 or 14 days, I can really feel the difference," said Abraham, a former nurse.

For Abraham, the arthritis drug Enbrel is a lifeline.

"It's kept me able to do for myself," she said. "If I take it, I don't have a flare-up. But if I stop it, I'll become more and more crippled and more and more in pain."

Stopping the drug is within the realm of possibility for Abraham, because Medicare won't pay for it while she is in the doughnut hole. Medicare provides coverage to seniors who spend $2,700 a year on drugs, but once that happens, they can't get benefits again until they have spent thousands of their own dollars.

Abraham is in that doughnut hole now, and it's a serious burden.

"After a few years of this, we won't have anything left," she said.

For seniors like Abraham, the health care law eliminates the doughnut hole, albeit very slowly. Such seniors will receive a $250 rebate this year and a 50 percent discount on name-brand prescriptions next year. After that, year by year, the doughnut hole will be narrowed until it disappears.

Unfortunately for Abraham, that won't happen until 2020.

"I wish they would close it a lot quicker," she said. "By that time, I'll be 74."

-- Jerry Zremski

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